A 57-year-old man with a 20-year history of episodic headache, flushing, hypotension, and occasional syncope

A 57-year-old man was diagnosed with systemic mastocytosis. He was admitted to the hospital suffering from low blood pressure and tightness in his chest. He had a 20-year history of headaches, flushing, tear discharge, low blood pressure and occasional fainting. The patient had a series of tests in the hospital, but he was discharged without a diagnosis. A follow-up examination found that the patient had an enlarged spleen, and a bone marrow biopsy indicated that he had indolent systemic mastocytosis. Systemic mastocytosis is a disorder in which mast cells, connective tissue cells involved in allergic reactions, move into the skin, lymph nodes, bone, blood, spleen and liver. Patients with this disease have 15- to 30-minute attacks with flushing, lightheadedness and heart palpitations. Other symptoms during attacks include headaches, chest pain, nausea, diarrhea and breathing difficulties. Seventy percent of patients with indolent systemic mastocytosis survive at least 10 years after diagnosis.